By Moncrief S.B. No. 414
75R3842 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to certain advance directives for medical treatment.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 ARTICLE 1. ADVANCE DIRECTIVES
1-5 SECTION 1.01. Subtitle H, Title 2, Health and Safety Code,
1-6 is amended by adding a chapter heading for Chapter 166 to read as
1-7 follows:
1-8 CHAPTER 166. ADVANCE DIRECTIVES
1-9 SECTION 1.02. Subtitle H, Title 2, Health and Safety Code,
1-10 is amended by adding Subchapter A, Chapter 166, to read as follows:
1-11 SUBCHAPTER A. GENERAL PROVISIONS
1-12 Sec. 166.001. SHORT TITLE. This chapter may be cited as
1-13 the Advance Directives Act.
1-14 Sec. 166.002. DEFINITIONS. In this chapter:
1-15 (1) "Advance directive" means:
1-16 (A) a directive, as that term is defined by
1-17 Section 166.031; or
1-18 (B) an out-of-hospital DNR order, as that term
1-19 is defined by Section 166.081.
1-20 (2) "Attending physician" means a physician selected
1-21 by or assigned to a patient who has primary responsibility for a
1-22 patient's treatment and care.
1-23 (3) "Competent" means possessing the ability, based on
1-24 reasonable medical judgment, to understand and appreciate the
2-1 nature and consequences of a treatment decision, including the
2-2 significant benefits and harms of and reasonable alternatives to a
2-3 proposed treatment decision.
2-4 (4) "Declarant" means a person who has executed or
2-5 issued a directive under this chapter.
2-6 (5) "Durable power of attorney for health care" means
2-7 a durable power of attorney for health care executed or issued
2-8 under Subchapter D.
2-9 (6) "Incompetent" means lacking the ability, based on
2-10 reasonable medical judgment, to understand and appreciate the
2-11 nature and consequences of a treatment decision, including the
2-12 significant benefits and harms of and reasonable alternatives to a
2-13 proposed treatment decision.
2-14 (7) "Life-sustaining procedure" has the meaning
2-15 assigned by Section 166.031 or 166.081, as appropriate.
2-16 (8) "Physician" means:
2-17 (A) a physician licensed by the Texas State
2-18 Board of Medical Examiners; or
2-19 (B) a properly credentialed physician who holds
2-20 a commission in the uniformed services of the United States and who
2-21 is serving on active duty in this state.
2-22 (9) "Terminal condition" means an incurable or
2-23 irreversible condition caused by injury, disease, or illness that
2-24 would produce death without the application of life-sustaining
2-25 procedures, according to reasonable medical judgment, and in which
2-26 the application of life-sustaining procedures serves only to
2-27 postpone the moment of the patient's death. A patient who has been
3-1 admitted to a program under which the person receives hospice
3-2 services provided by a home and community support services agency
3-3 licensed under Chapter 142 is presumed to have a terminal condition
3-4 for purposes of this chapter.
3-5 (10) "Witness" means a person who may serve as a
3-6 witness under Section 166.003.
3-7 Sec. 166.003. WITNESSES. (a) In any circumstance in which
3-8 this chapter requires the execution of an advance directive or the
3-9 issuance of a nonwritten advance directive to be witnessed, a
3-10 witness may not be:
3-11 (1) related to the declarant by blood or marriage;
3-12 (2) entitled to any part of the declarant's estate
3-13 after the declarant's death under a will or codicil executed by the
3-14 declarant or by operation of law;
3-15 (3) the attending physician;
3-16 (4) an employee of the attending physician;
3-17 (5) a patient in a health care facility in which the
3-18 declarant is a patient;
3-19 (6) a person who, at the time the directive is
3-20 executed or the nonwritten directive is issued, has a claim against
3-21 any part of the declarant's estate after the declarant's death; or
3-22 (7) an employee of a health care facility in which the
3-23 declarant is a patient if the employee is providing direct patient
3-24 care or is directly involved in the financial affairs of the
3-25 facility.
3-26 (b) For purposes of Subsection (a)(7), a person is directly
3-27 involved in the financial affairs of a health care facility if the
4-1 person serves as an officer, director, partner, or business office
4-2 employee of the health care facility or of any parent organization
4-3 of the health care facility.
4-4 SECTION 1.03. Chapter 672, Health and Safety Code, is
4-5 transferred to Subtitle H, Title 2, Health and Safety Code, is
4-6 redesignated as Subchapter B, Chapter 166, Health and Safety Code,
4-7 and is amended to read as follows:
4-8 SUBCHAPTER B [CHAPTER 672]. NATURAL DEATH [ACT]
4-9 [Sec. 672.001. SHORT TITLE. This chapter may be cited as
4-10 the Natural Death Act.]
4-11 Sec. 166.031 [672.002]. DEFINITIONS. In this subchapter
4-12 [chapter]:
4-13 (1) ["Attending physician" means the physician who has
4-14 primary responsibility for a patient's treatment and care.]
4-15 [(2) "Competent" means possessing the ability, based
4-16 on reasonable medical judgment, to understand and appreciate the
4-17 nature and consequences of a treatment decision, including the
4-18 significant benefits and harms of and reasonable alternatives to a
4-19 proposed treatment decision.]
4-20 [(3) "Declarant" means a person who has executed or
4-21 issued a directive under this chapter.]
4-22 [(4)] "Directive" means an instruction made under
4-23 Section 166.032, 166.034, or 166.035 [672.003, 672.005, or 672.006]
4-24 to withhold or withdraw life-sustaining procedures in the event of
4-25 a terminal condition.
4-26 (2) [(5) "Incompetent" means lacking the ability,
4-27 based on reasonable medical judgment, to understand and appreciate
5-1 the nature and consequences of a treatment decision, including the
5-2 significant benefits and harms of and reasonable alternatives to a
5-3 proposed treatment decision.]
5-4 [(6)] "Life-sustaining procedure" means a medical
5-5 procedure or intervention that uses mechanical or other artificial
5-6 means to sustain, restore, or supplant a vital function, and only
5-7 artificially postpones the moment of death of a patient in a
5-8 terminal condition whose death is imminent or will result within a
5-9 relatively short time without the application of the procedure.
5-10 The term does not include the administration of medication or the
5-11 performance of a medical procedure considered to be necessary to
5-12 provide comfort or care or to alleviate pain.
5-13 (3) [(7) "Physician" means a physician licensed by the
5-14 Texas State Board of Medical Examiners or a properly credentialed
5-15 physician who holds a commission in the uniformed services of the
5-16 United States and who is serving on active duty in this state.]
5-17 [(8)] "Qualified patient" means a patient with a
5-18 terminal condition that has been diagnosed and certified in writing
5-19 by the attending physician [and one other physician] who has [have]
5-20 personally examined the patient.
5-21 [(9) "Terminal condition" means an incurable or
5-22 irreversible condition caused by injury, disease, or illness that
5-23 would produce death without the application of life-sustaining
5-24 procedures, according to reasonable medical judgment, and in which
5-25 the application of life-sustaining procedures serves only to
5-26 postpone the moment of the patient's death.]
5-27 Sec. 166.032 [672.003]. WRITTEN DIRECTIVE BY COMPETENT
6-1 ADULT; NOTICE TO PHYSICIAN. (a) A competent adult may at any
6-2 time execute a written directive.
6-3 (b) The declarant must sign the directive in the presence of
6-4 two witnesses, and those witnesses must sign the directive.
6-5 (c) [A witness may not be:]
6-6 [(1) related to the declarant by blood or marriage;]
6-7 [(2) entitled to any part of the declarant's estate
6-8 after the declarant's death under a will or codicil executed by the
6-9 declarant or by operation of law;]
6-10 [(3) the attending physician;]
6-11 [(4) an employee of the attending physician;]
6-12 [(5) an employee of a health care facility in which
6-13 the declarant is a patient if the employee is providing direct
6-14 patient care to the declarant or is directly involved in the
6-15 financial affairs of the facility;]
6-16 [(6) a patient in a health care facility in which the
6-17 declarant is a patient; or]
6-18 [(7) a person who, at the time the directive is
6-19 executed, has a claim against any part of the declarant's estate
6-20 after the declarant's death.]
6-21 [(d)] A declarant may include in a directive directions
6-22 other than those provided by Section 166.033 [672.004] and may
6-23 designate in a directive a person to make a treatment decision for
6-24 the declarant in the event the declarant becomes comatose,
6-25 incompetent, or otherwise mentally or physically incapable of
6-26 communication.
6-27 (d) [(e)] A declarant shall notify the attending physician
7-1 of the existence of a written directive. If the declarant is
7-2 comatose, incompetent, or otherwise mentally or physically
7-3 incapable of communication, another person may notify the attending
7-4 physician of the existence of the written directive. The attending
7-5 physician shall make the directive a part of the declarant's
7-6 medical record.
7-7 Sec. 166.033 [672.004]. FORM OF WRITTEN DIRECTIVE. A
7-8 written directive may be in the following form:
7-9 "DIRECTIVE TO PHYSICIANS
7-10 "Directive made this __________ day of __________ (month,
7-11 year).
7-12 "I __________, being of sound mind, wilfully and voluntarily
7-13 make known my desire that my life shall not be artificially
7-14 prolonged under the circumstances set forth in this directive.
7-15 "1. If at any time I should have an incurable or
7-16 irreversible condition caused by injury, disease, or illness
7-17 certified to be a terminal condition by my attending physician [two
7-18 physicians], and if the application of life-sustaining procedures
7-19 would serve only to artificially postpone the moment of my death,
7-20 and if my attending physician determines that my death is imminent
7-21 or will result within a relatively short time without the
7-22 application of life-sustaining procedures, I direct that those
7-23 procedures be withheld or withdrawn, and that I be permitted to die
7-24 naturally.
7-25 "2. In the absence of my ability to give directions
7-26 regarding the use of those life-sustaining procedures, it is my
7-27 intention that this directive be honored by my family and
8-1 physicians as the final expression of my legal right to refuse
8-2 medical or surgical treatment and accept the consequences from that
8-3 refusal.
8-4 "3. If I have been diagnosed as pregnant and that diagnosis
8-5 is known to my physician, this directive has no effect during my
8-6 pregnancy.
8-7 "4. This directive is in effect until it is revoked.
8-8 "5. I understand the full import of this directive and I am
8-9 emotionally and mentally competent to make this directive.
8-10 "6. I understand that I may revoke this directive at any
8-11 time.
8-12 "Signed ______________
8-13 (City, County, and State of
8-14 Residence)
8-15 I am not related to the declarant by blood or marriage. I
8-16 would not be entitled to any portion of the declarant's estate on
8-17 the declarant's death. I am not the attending physician of the
8-18 declarant or an employee of the attending physician. I am not a
8-19 patient in the health care facility in which the declarant is a
8-20 patient. I have no claim against any portion of the declarant's
8-21 estate on the declarant's death. Furthermore, if I am an employee
8-22 of a health care facility in which the declarant is a patient, I am
8-23 not involved in providing direct patient care to the declarant and
8-24 am not an officer, director, partner, or business office employee
8-25 of the health care facility or of any parent organization of
8-26 the health care facility [directly involved in the financial
8-27 affairs of the health facility].
9-1 "Witness_________
9-2 "Witness_________"
9-3 Sec. 166.034 [672.005]. ISSUANCE OF NONWRITTEN DIRECTIVE BY
9-4 COMPETENT ADULT QUALIFIED PATIENT. (a) A competent qualified
9-5 patient who is an adult may issue a directive by a nonwritten means
9-6 of communication.
9-7 (b) A declarant must issue the nonwritten directive in the
9-8 presence of the attending physician and two witnesses. [The
9-9 witnesses must possess the same qualifications as are required by
9-10 Section 672.003(c).]
9-11 (c) The physician shall make the fact of the existence of
9-12 the directive a part of the declarant's medical record and the
9-13 witnesses shall sign the entry in the medical record.
9-14 Sec. 166.035 [672.006]. EXECUTION OF DIRECTIVE ON BEHALF OF
9-15 PATIENT YOUNGER THAN 18 YEARS OF AGE. The following persons may
9-16 execute a directive on behalf of a qualified patient who is younger
9-17 than 18 years of age:
9-18 (1) the patient's spouse, if the spouse is an adult;
9-19 (2) the patient's parents; or
9-20 (3) the patient's legal guardian.
9-21 Sec. 166.036. NOTARIZED DOCUMENT NOT REQUIRED; REQUIREMENT
9-22 OF SPECIFIC FORM PROHIBITED. (a) A written directive executed
9-23 under Section 166.033 or 166.035 is effective without regard to
9-24 whether the document has been notarized.
9-25 (b) A physician, health care facility, or health care
9-26 professional may not require that:
9-27 (1) a directive be notarized; or
10-1 (2) a person use a form provided by the physician,
10-2 health care facility, or health care professional.
10-3 Sec. 166.037 [672.007]. PATIENT DESIRE SUPERSEDES DIRECTIVE.
10-4 The desire of a competent qualified patient, including a competent
10-5 qualified patient younger than 18 years of age, supersedes the
10-6 effect of a directive.
10-7 Sec. 166.038 [672.008]. PROCEDURE WHEN DECLARANT IS
10-8 INCOMPETENT OR INCAPABLE OF COMMUNICATION. (a) This section
10-9 applies when an adult qualified patient has executed or issued a
10-10 directive and is comatose, incompetent, or otherwise mentally or
10-11 physically incapable of communication.
10-12 (b) If the adult qualified patient has designated a person
10-13 to make a treatment decision as authorized by Section 166.032(c)
10-14 [672.003(d)], the attending physician and the designated person may
10-15 make a treatment decision to withhold or withdraw life-sustaining
10-16 procedures from the patient.
10-17 (c) If the adult qualified patient has not designated a
10-18 person to make a treatment decision, the attending physician shall
10-19 comply with the directive unless the physician believes that the
10-20 directive does not reflect the patient's present desire.
10-21 Sec. 166.039 [672.009]. PROCEDURE WHEN PERSON HAS NOT
10-22 EXECUTED OR ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF
10-23 COMMUNICATION. (a) If an adult qualified patient has not executed
10-24 or issued a directive and is comatose, incompetent, or otherwise
10-25 mentally or physically incapable of communication, the attending
10-26 physician and the patient's legal guardian or an agent under a
10-27 durable power of attorney for health care may make a treatment
11-1 decision that may include a decision to withhold or withdraw
11-2 life-sustaining procedures from the patient.
11-3 (b) If the patient does not have a legal guardian, the
11-4 attending physician and one person from one [at least two persons,
11-5 if available,] of the following categories, in the following
11-6 priority, may make a treatment decision that may include a decision
11-7 to withhold or withdraw life-sustaining procedures:
11-8 (1) the patient's spouse;
11-9 (2) [a majority of] the patient's reasonably available
11-10 adult children;
11-11 (3) the patient's parents; or
11-12 (4) the patient's nearest living relative.
11-13 (c) A treatment decision made under Subsection (a) or (b)
11-14 must be based on knowledge of what the patient would desire, if
11-15 known.
11-16 (d) A treatment decision made under Subsection (b) must be
11-17 made in the presence of at least two witnesses who possess the same
11-18 qualifications and are subject to the same restrictions as provided
11-19 [as are required] by Section 166.003 [672.003(c)].
11-20 (e) The fact that an adult qualified patient has not
11-21 executed or issued a directive does not create a presumption that
11-22 the patient does not want a treatment decision to be made to
11-23 withhold or withdraw life-sustaining procedures.
11-24 Sec. 166.040 [672.010]. PATIENT CERTIFICATION AND
11-25 PREREQUISITES FOR COMPLYING WITH DIRECTIVE. (a) An attending
11-26 physician who has been notified of the existence of a directive
11-27 shall provide for the declarant's certification as a qualified
12-1 patient on diagnosis of a terminal condition.
12-2 (b) Before withholding or withdrawing life-sustaining
12-3 procedures from a qualified patient under this subchapter
12-4 [chapter], the attending physician must:
12-5 (1) determine that the patient's death is imminent or
12-6 will result within a relatively short time without application of
12-7 those procedures;
12-8 (2) note that determination in the patient's medical
12-9 record; and
12-10 (3) determine that the steps proposed to be taken are
12-11 in accord with this subchapter [chapter] and the patient's existing
12-12 desires.
12-13 Sec. 166.041 [672.011]. DURATION OF DIRECTIVE. A directive
12-14 is effective until it is revoked as prescribed by Section 166.042
12-15 [672.012].
12-16 Sec. 166.042 [672.012]. REVOCATION OF DIRECTIVE. (a) A
12-17 declarant may revoke a directive at any time without regard to the
12-18 declarant's mental state or competency. A directive may be revoked
12-19 by:
12-20 (1) the declarant or someone in the declarant's
12-21 presence and at the declarant's direction canceling, defacing,
12-22 obliterating, burning, tearing, or otherwise destroying the
12-23 directive;
12-24 (2) the declarant signing and dating a written
12-25 revocation that expresses the declarant's intent to revoke the
12-26 directive; or
12-27 (3) the declarant orally stating the declarant's
13-1 intent to revoke the directive.
13-2 (b) A written revocation executed as prescribed by
13-3 Subsection (a)(2) takes effect only when the declarant or a person
13-4 acting on behalf of the declarant notifies the attending physician
13-5 of its existence or mails the revocation to the attending
13-6 physician. The attending physician or the physician's designee
13-7 shall record in the patient's medical record the time and date when
13-8 the physician received notice of the written revocation and shall
13-9 enter the word "VOID" on each page of the copy of the directive in
13-10 the patient's medical record.
13-11 (c) An oral revocation issued as prescribed by Subsection
13-12 (a)(3) takes effect only when the declarant or a person acting on
13-13 behalf of the declarant notifies the attending physician of the
13-14 revocation. The attending physician or the physician's designee
13-15 shall record in the patient's medical record the time, date, and
13-16 place of the revocation, and, if different, the time, date, and
13-17 place that the physician received notice of the revocation. The
13-18 attending physician or the physician's designees shall also enter
13-19 the word "VOID" on each page of the copy of the directive in the
13-20 patient's medical record.
13-21 (d) Except as otherwise provided by this subchapter
13-22 [chapter], a person is not civilly or criminally liable for failure
13-23 to act on a revocation made under this section unless the person
13-24 has actual knowledge of the revocation.
13-25 Sec. 166.043 [672.013]. REEXECUTION OF DIRECTIVE. A
13-26 declarant may at any time reexecute a directive in accordance with
13-27 the procedures prescribed by Section 166.032 [672.003], including
14-1 reexecution after the declarant is diagnosed as having a terminal
14-2 condition.
14-3 Sec. 166.044 [672.014]. EFFECT OF DIRECTIVE ON INSURANCE
14-4 POLICY AND PREMIUMS. (a) The fact that a person has executed or
14-5 issued a directive under this subchapter [chapter] does not:
14-6 (1) restrict, inhibit, or impair in any manner the
14-7 sale, procurement, or issuance of a life insurance policy to that
14-8 person; or
14-9 (2) modify the terms of an existing life insurance
14-10 policy.
14-11 (b) Notwithstanding the terms of any life insurance policy,
14-12 the fact that life-sustaining procedures are withheld or withdrawn
14-13 from an insured qualified patient under this subchapter [chapter]
14-14 does not legally impair or invalidate that person's life insurance
14-15 policy.
14-16 (c) A physician, health facility, health provider, insurer,
14-17 or health care service plan may not require a person to execute or
14-18 issue a directive as a condition for obtaining insurance for health
14-19 care services or receiving health care services.
14-20 (d) The fact that a person has executed or issued or failed
14-21 to execute or issue a directive under this subchapter [chapter] may
14-22 not be considered in any way in establishing insurance premiums.
14-23 Sec. 166.045 [672.015]. LIMITATION OF LIABILITY FOR
14-24 WITHHOLDING OR WITHDRAWING LIFE-SUSTAINING PROCEDURES. (a) A
14-25 physician or health facility that, in good faith, causes
14-26 life-sustaining procedures to be withheld or withdrawn from a
14-27 qualified patient in accordance with this subchapter [chapter] is
15-1 not civilly liable for that action [unless negligent].
15-2 (b) A health professional, acting under the direction of a
15-3 physician, who participates, in good faith, in withholding or
15-4 withdrawing life-sustaining procedures from a qualified patient in
15-5 accordance with this subchapter [chapter] is not civilly liable for
15-6 that action [unless negligent].
15-7 (c) A physician, or a health professional acting under the
15-8 direction of a physician, who participates, in good faith, in
15-9 withholding or withdrawing life-sustaining procedures from a
15-10 qualified patient in accordance with this subchapter [chapter] is
15-11 not criminally liable or guilty of unprofessional conduct as a
15-12 result of that action [unless negligent].
15-13 Sec. 166.046 [672.016]. LIMITATION OF LIABILITY FOR FAILURE
15-14 TO EFFECTUATE DIRECTIVE. (a) A physician, health care facility,
15-15 or health care professional who has no knowledge of a directive is
15-16 not civilly or criminally liable for failing to act in accordance
15-17 with the directive.
15-18 (b) A physician, or a health professional acting under the
15-19 direction of a physician, is not civilly or criminally liable for
15-20 failing to effectuate a qualified patient's directive.
15-21 (c) If an attending physician refuses to comply with a
15-22 directive or treatment decision, the physician shall make a
15-23 reasonable effort to transfer the patient to another physician.
15-24 Sec. 166.047 [672.017]. HONORING DIRECTIVE DOES NOT
15-25 CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not commit an
15-26 offense under Section 22.08, Penal Code, by withholding or
15-27 withdrawing life-sustaining procedures from a qualified patient in
16-1 accordance with this subchapter [chapter].
16-2 Sec. 166.048 [672.018]. CRIMINAL PENALTY; PROSECUTION.
16-3 (a) A person commits an offense if the person intentionally
16-4 conceals, cancels, defaces, obliterates, or damages another
16-5 person's directive without that person's consent. An offense under
16-6 this subsection is a Class A misdemeanor.
16-7 (b) A person is subject to prosecution for criminal homicide
16-8 under Chapter 19, Penal Code, if the person, with the intent to
16-9 cause life-sustaining procedures to be withheld or withdrawn from
16-10 another person contrary to the other person's desires, falsifies or
16-11 forges a directive or intentionally conceals or withholds personal
16-12 knowledge of a revocation and thereby directly causes
16-13 life-sustaining procedures to be withheld or withdrawn from the
16-14 other person with the result that the other person's death is
16-15 hastened.
16-16 Sec. 166.049 [672.019]. PREGNANT PATIENTS. A person may not
16-17 withdraw or withhold life-sustaining procedures under this
16-18 subchapter [chapter] from a pregnant patient.
16-19 Sec. 166.050 [672.020]. MERCY KILLING NOT CONDONED. This
16-20 subchapter [chapter] does not condone, authorize, or approve mercy
16-21 killing or permit an affirmative or deliberate act or omission to
16-22 end life except to permit the natural process of dying as provided
16-23 by this subchapter [chapter].
16-24 Sec. 166.051 [672.021]. LEGAL RIGHT OR RESPONSIBILITY NOT
16-25 AFFECTED. This subchapter [chapter] does not impair or supersede
16-26 any legal right or responsibility a person may have to effect the
16-27 withholding or withdrawal of life-sustaining procedures in a lawful
17-1 manner.
17-2 SECTION 1.04. Chapter 674, Health and Safety Code, is
17-3 transferred to Subtitle H, Title 2, Health and Safety Code, is
17-4 redesignated as Subchapter C, Chapter 166, Health and Safety Code,
17-5 and is amended to read as follows:
17-6 SUBCHAPTER C [CHAPTER 674]. OUT-OF-HOSPITAL
17-7 DO-NOT-RESUSCITATE ORDERS
17-8 Sec. 166.081 [674.001]. DEFINITIONS. In this subchapter
17-9 [chapter]:
17-10 (1) ["Attending physician" means the physician who has
17-11 primary responsibility for a person's treatment and care.]
17-12 [(2) "Board" means the Texas Board of Health.]
17-13 [(3)] "Cardiopulmonary resuscitation" includes a
17-14 component of cardiopulmonary resuscitation.
17-15 (2) [(4) "Competent" means possessing the ability,
17-16 based on reasonable medical judgment, to understand and appreciate
17-17 the nature and consequences of a treatment decision, including the
17-18 significant benefits and harms of, and reasonable alternatives to,
17-19 a proposed treatment decision.]
17-20 [(5) "Declarant" means a person who has executed or
17-21 issued an out-of-hospital do-not-resuscitate order under this
17-22 chapter.]
17-23 [(6) "Department" means the Texas Department of
17-24 Health.]
17-25 [(7)] "DNR identification device" means an
17-26 identification device specified by the board under Section 166.103
17-27 [674.023] that is worn for the purpose of identifying a person who
18-1 has executed or issued an out-of-hospital DNR order or on whose
18-2 behalf an out-of-hospital DNR order has been executed or issued
18-3 under this subchapter [chapter].
18-4 (3) [(8) "Durable power of attorney for health care"
18-5 means a document delegating to an agent the authority to make
18-6 health care decisions for a person in accordance with Chapter 135,
18-7 Civil Practice and Remedies Code.]
18-8 [(9)] "Emergency medical services" has the meaning
18-9 assigned by Section 773.003.
18-10 (4) [(10)] "Emergency medical services personnel" has
18-11 the meaning assigned by Section 773.003.
18-12 (5) [(11)] "Health care professionals" means
18-13 physicians, nurses, and emergency medical services personnel and,
18-14 unless the context requires otherwise, includes hospital emergency
18-15 personnel.
18-16 (6) [(12) "Incompetent" means lacking the ability,
18-17 based on reasonable medical judgment, to understand and appreciate
18-18 the nature and consequences of a treatment decision, including the
18-19 significant benefits and harms of, and reasonable alternatives to,
18-20 a proposed treatment decision.]
18-21 [(13)] "Life-sustaining procedure" means a medical
18-22 procedure, treatment, or intervention that uses mechanical or other
18-23 artificial means to sustain, restore, or supplant a [spontaneous]
18-24 vital function and, when applied to a person in a terminal
18-25 condition, serves only to prolong the process of dying. The term
18-26 does not include the administration of medication or the
18-27 performance of a medical procedure considered to be necessary to
19-1 provide comfort or care or to alleviate pain [or the provision of
19-2 water or nutrition].
19-3 (7) [(14)] "Out-of-hospital DNR order":
19-4 (A) means a legally binding out-of-hospital
19-5 do-not-resuscitate order, in the form specified by the board under
19-6 Section 166.083 [674.003], prepared and signed by the attending
19-7 physician of a person who has been diagnosed as having a terminal
19-8 condition, that documents the instructions of a person or the
19-9 person's legally authorized representative and directs health care
19-10 professionals acting in an out-of-hospital setting not to initiate
19-11 or continue the following life-sustaining procedures:
19-12 (i) cardiopulmonary resuscitation;
19-13 (ii) endotracheal intubation or other
19-14 means of advanced airway management;
19-15 (iii) artificial ventilation;
19-16 (iv) defibrillation;
19-17 (v) transcutaneous cardiac pacing;
19-18 (vi) the administration of cardiac
19-19 resuscitation medications; and
19-20 (vii) other life-sustaining procedures
19-21 specified by the board under Section 166.103(a) [674.023(a)]; and
19-22 (B) does not include authorization to withhold
19-23 medical interventions or therapies considered necessary to provide
19-24 comfort or care or to alleviate pain [or to provide water or
19-25 nutrition].
19-26 (8) [(15)] "Out-of-hospital setting" means any setting
19-27 outside of a licensed acute care hospital in which health care
20-1 professionals are called for assistance, including long-term care
20-2 facilities, in-patient hospice facilities, private homes, and
20-3 vehicles during transport.
20-4 (9) [(16) "Physician" means a physician licensed by
20-5 the Texas State Board of Medical Examiners or a properly
20-6 credentialed physician who holds a commission in the uniformed
20-7 services of the United States and who is serving on active duty in
20-8 this state.]
20-9 [(17)] "Proxy" means a person designated and
20-10 authorized by a directive executed or issued in accordance with
20-11 Subchapter B [Chapter 672] to make a treatment decision for another
20-12 person in the event the other person becomes comatose, incompetent,
20-13 or otherwise mentally or physically incapable of communication.
20-14 (10) [(18)] "Qualified relatives" means those persons
20-15 authorized to execute or issue an out-of-hospital DNR order on
20-16 behalf of a person who is comatose, incompetent, or otherwise
20-17 mentally or physically incapable of communication under Section
20-18 166.088 [674.008].
20-19 (11) [(19)] "Statewide out-of-hospital DNR protocol"
20-20 means a set of statewide standardized procedures adopted by the
20-21 board under Section 166.103 [674.023] for withholding
20-22 cardiopulmonary resuscitation and certain other life-sustaining
20-23 procedures by health care professionals acting in out-of-hospital
20-24 settings.
20-25 [(20) "Terminal condition" means an incurable or
20-26 irreversible condition caused by injury, disease, or illness that
20-27 would produce death without the application of life-sustaining
21-1 procedures, according to reasonable medical judgment, and in which
21-2 the application of life-sustaining procedures serves only to
21-3 postpone the moment of the person's death.]
21-4 Sec. 166.082 [674.002]. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE
21-5 TO PHYSICIANS. (a) A competent person who has been diagnosed by a
21-6 physician as having a terminal condition may at any time execute a
21-7 written out-of-hospital DNR order directing health care
21-8 professionals acting in an out-of-hospital setting to withhold
21-9 cardiopulmonary resuscitation and certain other life-sustaining
21-10 procedures designated by the board.
21-11 (b) The declarant must sign the out-of-hospital DNR order in
21-12 the presence of two witnesses, and those witnesses must sign the
21-13 order. The attending physician of the declarant must sign the
21-14 order and shall make the fact of the existence of the order and the
21-15 reasons for execution of the order a part of the declarant's
21-16 medical record.
21-17 (c) [A witness must have the same qualifications as those
21-18 provided by Section 672.003(c).]
21-19 [(d)] If the person is incompetent but previously executed
21-20 or issued a directive to physicians in accordance with Subchapter B
21-21 [Chapter 672], the physician may rely on the directive as the
21-22 person's instructions to issue an out-of-hospital DNR order and
21-23 shall place a copy of the directive in the person's medical record.
21-24 The physician shall sign the order in lieu of the person signing
21-25 under Subsection (b).
21-26 (d) [(e)] If the person is incompetent but previously
21-27 executed or issued a directive to physicians in accordance with
22-1 Subchapter B [Chapter 672] designating a proxy, the proxy may make
22-2 any decisions required of the designating person as to an
22-3 out-of-hospital DNR order and shall sign the order in lieu of the
22-4 person signing under Subsection (b).
22-5 (e) [(f)] If the person is now incompetent but previously
22-6 executed or issued a durable power of attorney for health care [in
22-7 accordance with Chapter 135, Civil Practice and Remedies Code],
22-8 designating an agent, the agent may make any decisions required of
22-9 the designating person as to an out-of-hospital DNR order and shall
22-10 sign the order in lieu of the person signing under Subsection (b).
22-11 (f) [(g)] The board, on the recommendation of the
22-12 department, shall by rule adopt procedures for the disposition and
22-13 maintenance of records of an original out-of-hospital DNR order and
22-14 any copies of the order.
22-15 (g) [(h)] An out-of-hospital DNR order is effective on its
22-16 execution.
22-17 Sec. 166.083 [674.003]. FORM OF OUT-OF-HOSPITAL DNR ORDER.
22-18 (a) A written out-of-hospital DNR order shall be in the standard
22-19 form specified by board rule as recommended by the department.
22-20 (b) The standard form of an out-of-hospital DNR order
22-21 specified by the board must, at a minimum, contain the following:
22-22 (1) a distinctive single-page format that readily
22-23 identifies the document as an out-of-hospital DNR order;
22-24 (2) a title that readily identifies the document as an
22-25 out-of-hospital DNR order;
22-26 (3) the printed or typed name of the person;
22-27 (4) a statement that the physician signing the
23-1 document is the attending physician of the person, that the
23-2 physician has diagnosed the person as having a terminal condition,
23-3 and that the physician is directing health care professionals
23-4 acting in out-of-hospital settings not to initiate or continue
23-5 certain life-sustaining procedures on behalf of the person, and a
23-6 listing of those procedures not to be initiated or continued;
23-7 (5) a statement that the person understands that the
23-8 person may revoke the out-of-hospital DNR order at any time by
23-9 destroying the order and removing the DNR identification device, if
23-10 any, or by communicating to health care professionals at the scene
23-11 the person's desire to revoke the out-of-hospital DNR order;
23-12 (6) places for the printed names and signatures of the
23-13 witnesses and attending physician of the person and the medical
23-14 license number of the attending physician;
23-15 (7) a separate section for execution of the document
23-16 by the legal guardian of the person, the person's proxy, an agent
23-17 of the person having a durable power of attorney for health care,
23-18 or the attending physician attesting to the issuance of an
23-19 out-of-hospital DNR order by nonwritten means of communication or
23-20 acting in accordance with a previously executed or previously
23-21 issued directive to physicians under Section 166.082(c)
23-22 [674.002(d)] that includes the following:
23-23 (A) a statement that the legal guardian, the
23-24 proxy, the agent, the person by nonwritten means of communication,
23-25 or the physician directs that the listed life-sustaining procedures
23-26 should not be initiated or continued in behalf of the person; and
23-27 (B) places for the printed names and signatures
24-1 of the witnesses and, as applicable, the legal guardian, proxy,
24-2 agent, or physician;
24-3 (8) a separate section for execution of the document
24-4 by at least two qualified relatives of the person when the person
24-5 does not have a legal guardian, proxy, or agent having a durable
24-6 power of attorney for health care and is comatose, incompetent, or
24-7 otherwise mentally or physically incapable of communication,
24-8 including:
24-9 (A) a statement that the relatives of the person
24-10 are qualified to make a treatment decision to withhold
24-11 cardiopulmonary resuscitation and certain other designated
24-12 life-sustaining procedures under Section 166.088 [674.008] and,
24-13 based on the known desires of the person or a determination of the
24-14 best interest of the person, direct that the listed life-sustaining
24-15 procedures should not be initiated or continued in behalf of the
24-16 person; and
24-17 (B) places for the printed names and signatures
24-18 of the witnesses and qualified relatives of the person;
24-19 (9) a place for entry of the date of execution of the
24-20 document;
24-21 (10) a statement that the document is in effect on the
24-22 date of its execution and remains in effect until the death of the
24-23 person or until the document is revoked;
24-24 (11) a statement that the document must accompany the
24-25 person during transport;
24-26 (12) a statement regarding the proper disposition of
24-27 the document or copies of the document, as the board determines
25-1 appropriate; and
25-2 (13) a statement at the bottom of the document, with
25-3 places for the signature of each person executing the document,
25-4 that the document has been properly completed.
25-5 (c) The board may, by rule and as recommended by the
25-6 department, modify the standard form of the out-of-hospital DNR
25-7 order described by Subsection (b) in order to accomplish the
25-8 purposes of this subchapter [chapter].
25-9 Sec. 166.084 [674.004]. ISSUANCE OF OUT-OF-HOSPITAL DNR
25-10 ORDER BY NONWRITTEN COMMUNICATION. (a) A competent person who is
25-11 an adult may issue an out-of-hospital DNR order by nonwritten
25-12 communication.
25-13 (b) A declarant must issue the nonwritten out-of-hospital
25-14 DNR order in the presence of the attending physician and two
25-15 witnesses. [The witnesses must possess the same qualifications as
25-16 those provided by Section 672.003(c).]
25-17 (c) The attending physician and witnesses shall sign the
25-18 out-of-hospital DNR order in the [that] place of the document
25-19 provided by Section 166.083(b)(7) [674.003(b)(7)] and the attending
25-20 physician shall sign the document in the place required by Section
25-21 166.083(b)(13) [674.003(b)(13)]. The physician shall make the fact
25-22 of the existence of the out-of-hospital DNR order a part of the
25-23 declarant's medical record and the witnesses shall sign that entry
25-24 in the medical record.
25-25 (d) An out-of-hospital DNR order issued in the manner
25-26 provided by this section is valid and shall be honored by
25-27 responding health care professionals as if executed in the manner
26-1 provided by Section 166.082 [674.002].
26-2 Sec. 166.085 [674.005]. EXECUTION OF OUT-OF-HOSPITAL DNR
26-3 ORDER ON BEHALF OF A MINOR. The following persons may execute an
26-4 out-of-hospital DNR order on behalf of a minor:
26-5 (1) the minor's parents;
26-6 (2) the minor's legal guardian; or
26-7 (3) the minor's managing conservator.
26-8 Sec. 166.086 [674.006]. DESIRE OF PERSON SUPERSEDES
26-9 OUT-OF-HOSPITAL DNR ORDER. The desire of a competent person,
26-10 including a competent minor, supersedes the effect of an
26-11 out-of-hospital DNR order executed or issued by or on behalf of the
26-12 person when the desire is communicated to responding health care
26-13 professionals as provided by this subchapter [chapter].
26-14 Sec. 166.087 [674.007]. PROCEDURE WHEN DECLARANT IS
26-15 INCOMPETENT OR INCAPABLE OF COMMUNICATION. (a) This section
26-16 applies when a person 18 years of age or older has executed or
26-17 issued an out-of-hospital DNR order and subsequently becomes
26-18 comatose, incompetent, or otherwise mentally or physically
26-19 incapable of communication.
26-20 (b) If the adult person has designated a person to make a
26-21 treatment decision as authorized by Section 166.032(c)
26-22 [672.003(d)], the attending physician and the designated person
26-23 shall comply with the out-of-hospital DNR order.
26-24 (c) If the adult person has not designated a person to make
26-25 a treatment decision as authorized by Section 166.032(c)
26-26 [672.003(d)], the attending physician shall comply with the
26-27 out-of-hospital DNR order unless the physician believes that the
27-1 order does not reflect the person's present desire.
27-2 Sec. 166.088 [674.008]. PROCEDURE WHEN PERSON HAS NOT
27-3 EXECUTED OR ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR
27-4 INCAPABLE OF COMMUNICATION. (a) If an adult person has not
27-5 executed or issued an out-of-hospital DNR order and is comatose,
27-6 incompetent, or otherwise mentally or physically incapable of
27-7 communication, the attending physician and the person's legal
27-8 guardian, proxy, or agent having a durable power of attorney for
27-9 health care may execute an out-of-hospital DNR order on behalf of
27-10 the person.
27-11 (b) If the person does not have a legal guardian, proxy, or
27-12 agent, the attending physician and at least two qualified relatives
27-13 may execute an out-of-hospital DNR order in the same manner as a
27-14 treatment decision made under Section 166.039(b) [672.009(b)].
27-15 (c) A decision to execute an out-of-hospital DNR order made
27-16 under Subsection (a) or (b) must be based on knowledge of what the
27-17 person would desire, if known.
27-18 (d) An out-of-hospital DNR order executed under Subsection
27-19 (b) must be made in the presence of at least two witnesses [who
27-20 possess the same qualifications that are required by Section
27-21 672.003(c)].
27-22 (e) The fact that an adult person has not executed or issued
27-23 an out-of-hospital DNR order does not create a presumption that the
27-24 person does not want a treatment decision made to withhold
27-25 cardiopulmonary resuscitation and certain other designated
27-26 life-sustaining procedures designated by the board.
27-27 Sec. 166.089 [674.009]. COMPLIANCE WITH OUT-OF-HOSPITAL DNR
28-1 ORDER. (a) When responding to a call for assistance, health care
28-2 professionals shall honor an out-of-hospital DNR order in
28-3 accordance with the statewide out-of-hospital DNR protocol and,
28-4 where applicable, locally adopted out-of-hospital DNR protocols not
28-5 in conflict with the statewide protocol if:
28-6 (1) the responding health care professionals discover
28-7 an executed or issued out-of-hospital DNR order form on their
28-8 arrival at the scene; and
28-9 (2) the responding health care professionals comply
28-10 with this section.
28-11 (b) If the person is wearing a DNR identification device,
28-12 the responding health care professionals must comply with Section
28-13 166.090 [674.010].
28-14 (c) The responding health care professionals must establish
28-15 the identity of the person as the person who executed or issued the
28-16 out-of-hospital DNR order or for whom the out-of-hospital DNR order
28-17 was executed or issued.
28-18 (d) The responding health care professionals must determine
28-19 that the out-of-hospital DNR order form appears to be valid in that
28-20 it includes:
28-21 (1) written responses in the places designated on the
28-22 form for the names, signatures, and other information required of
28-23 persons executing or issuing, or witnessing the execution or
28-24 issuance of, the order;
28-25 (2) a date in the place designated on the form for the
28-26 date the order was executed or issued; and
28-27 (3) the signature of the declarant or persons
29-1 executing or issuing the order and the attending physician in the
29-2 appropriate places designated on the form for indicating that the
29-3 order form has been properly completed.
29-4 (e) If the conditions prescribed by Subsections (a) through
29-5 (d) are not determined to apply by the responding health care
29-6 professionals at the scene, the out-of-hospital DNR order may not
29-7 be honored and life-sustaining procedures otherwise required by law
29-8 or local emergency medical services protocols shall be initiated or
29-9 continued. Health care professionals acting in out-of-hospital
29-10 settings are not required to accept or interpret an out-of-hospital
29-11 DNR order that does not meet the requirements of this chapter.
29-12 (f) The out-of-hospital DNR order form, when available, must
29-13 accompany the person during transport.
29-14 (g) A record shall be made and maintained of the
29-15 circumstances of each emergency medical services response in which
29-16 an out-of-hospital DNR order or DNR identification device is
29-17 encountered, in accordance with the statewide out-of-hospital DNR
29-18 protocol and any applicable local out-of-hospital DNR protocol not
29-19 in conflict with the statewide protocol.
29-20 (h) An out-of-hospital DNR order executed or issued and
29-21 documented or evidenced in the manner prescribed by this subchapter
29-22 [chapter] is valid and shall be honored by responding health care
29-23 professionals unless the person or persons found at the scene:
29-24 (1) identify themselves as the declarant or as the
29-25 attending physician, legal guardian, qualified relative, or agent
29-26 of the person having a durable power of attorney for health care
29-27 who executed or issued the out-of-hospital DNR order on behalf of
30-1 the person; and
30-2 (2) request that cardiopulmonary resuscitation or
30-3 certain other life-sustaining procedures designated by the board be
30-4 initiated or continued.
30-5 (i) If the policies of a health care facility preclude
30-6 compliance with the out-of-hospital DNR order of a person or an
30-7 out-of-hospital DNR order issued by an attending physician on
30-8 behalf of a person who is admitted to or a resident of the
30-9 facility, or if the facility is unwilling to accept DNR
30-10 identification devices as evidence of the existence of an
30-11 out-of-hospital DNR order, that facility shall take all reasonable
30-12 steps to notify the person or, if the person is incompetent, the
30-13 person's guardian or the person or persons having authority to make
30-14 health care treatment decisions on behalf of the person, of the
30-15 facility's policy and shall take all reasonable steps to effect the
30-16 transfer of the person to the person's home or to a facility where
30-17 the provisions of this subchapter [chapter] can be carried out.
30-18 Sec. 166.090 [674.010]. DNR IDENTIFICATION DEVICE. (a) A
30-19 person who has a valid out-of-hospital DNR order under this
30-20 subchapter [chapter] may wear a DNR identification device around
30-21 the neck or on the wrist as prescribed by board rule adopted under
30-22 Section 166.103 [674.023].
30-23 (b) The presence of a DNR identification device on the body
30-24 of a person is conclusive evidence that the person has executed or
30-25 issued a valid out-of-hospital DNR order or has a valid
30-26 out-of-hospital DNR order executed or issued on the person's
30-27 behalf. Responding health care professionals shall honor the DNR
31-1 identification device as if a valid out-of-hospital DNR order form
31-2 executed or issued by the person were found in the possession of
31-3 the person.
31-4 Sec. 166.091 [674.011]. DURATION OF OUT-OF-HOSPITAL DNR
31-5 ORDER. An out-of-hospital DNR order is effective until it is
31-6 revoked as prescribed by Section 166.092 [674.012].
31-7 Sec. 166.092 [674.012]. REVOCATION OF OUT-OF-HOSPITAL DNR
31-8 ORDER. (a) A declarant may revoke an out-of-hospital DNR order
31-9 at any time without regard to the declarant's mental state or
31-10 competency. An order may be revoked by:
31-11 (1) the declarant or someone in the declarant's
31-12 presence and at the declarant's direction destroying the order form
31-13 and removing the DNR identification device, if any;
31-14 (2) a person who identifies himself or herself as the
31-15 legal guardian, as a qualified relative, or as the agent of the
31-16 declarant having a durable power of attorney for health care who
31-17 executed the out-of-hospital DNR order or another person in the
31-18 person's presence and at the person's direction destroying the
31-19 order form and removing the DNR identification device, if any;
31-20 (3) the declarant communicating the declarant's intent
31-21 to revoke the order; or
31-22 (4) a person who identifies himself or herself as the
31-23 legal guardian, a qualified relative, or the agent of the declarant
31-24 having a durable power of attorney for health care who executed the
31-25 out-of-hospital DNR order orally stating the person's intent to
31-26 revoke the order.
31-27 (b) An oral revocation under Subsection (a)(3) or (a)(4)
32-1 takes effect only when the declarant or a person who identifies
32-2 himself or herself as the legal guardian, a qualified relative, or
32-3 the agent of the declarant having a durable power of attorney for
32-4 health care who executed the out-of-hospital DNR order communicates
32-5 the intent to revoke the order to the responding health care
32-6 professionals or the attending physician at the scene. The
32-7 responding health care professionals shall record the time, date,
32-8 and place of the revocation in accordance with the statewide
32-9 out-of-hospital DNR protocol and rules adopted by the board and any
32-10 applicable local out-of-hospital DNR protocol. The attending
32-11 physician or the physician's designee shall record in the person's
32-12 medical record the time, date, and place of the revocation and, if
32-13 different, the time, date, and place that the physician received
32-14 notice of the revocation. The attending physician or the
32-15 physician's designee shall also enter the word "VOID" on each page
32-16 of the copy of the order in the person's medical record.
32-17 (c) Except as otherwise provided by this subchapter
32-18 [chapter], a person is not civilly or criminally liable for failure
32-19 to act on a revocation made under this section unless the person
32-20 has actual knowledge of the revocation.
32-21 Sec. 166.093 [674.013]. REEXECUTION OF OUT-OF-HOSPITAL DNR
32-22 ORDER. A declarant may at any time reexecute or reissue an
32-23 out-of-hospital DNR order in accordance with the procedures
32-24 prescribed by Section 166.082 [674.002], including reexecution or
32-25 reissuance after the declarant is diagnosed as having a terminal
32-26 condition.
32-27 Sec. 166.094 [674.014]. CONFLICT WITH NATURAL DEATH ACT OR
33-1 DURABLE POWER OF ATTORNEY FOR HEALTH CARE. To the extent that an
33-2 out-of-hospital DNR order conflicts with a directive or treatment
33-3 decision executed or issued under Subchapter B [Chapter 672] or a
33-4 durable power of attorney for health care [executed or issued in
33-5 accordance with Chapter 135, Civil Practice and Remedies Code], the
33-6 instrument executed later in time controls.
33-7 Sec. 166.095 [674.015]. EFFECT OF OUT-OF-HOSPITAL DNR ORDER
33-8 ON INSURANCE POLICY AND PREMIUMS. (a) The fact that a person has
33-9 executed or issued an out-of-hospital DNR order under this
33-10 subchapter [chapter] does not:
33-11 (1) restrict, inhibit, or impair in any manner the
33-12 sale, procurement, or issuance of a life insurance policy to that
33-13 person; or
33-14 (2) modify the terms of an existing life insurance
33-15 policy.
33-16 (b) Notwithstanding the terms of any life insurance policy,
33-17 the fact that cardiopulmonary resuscitation or certain other
33-18 life-sustaining procedures designated by the board are withheld
33-19 from an insured person under this subchapter [chapter] does not
33-20 legally impair or invalidate that person's life insurance policy
33-21 and may not be a factor for the purpose of determining the
33-22 payability of benefits or the cause of death under the life
33-23 insurance policy.
33-24 (c) A physician, health facility, health care provider,
33-25 insurer, or health care service plan may not require a person to
33-26 execute or issue an out-of-hospital DNR order as a condition for
33-27 obtaining insurance for health care services or receiving health
34-1 care services.
34-2 (d) The fact that a person has executed or issued or failed
34-3 to execute or issue an out-of-hospital DNR order under this
34-4 subchapter [chapter] may not be considered in any way in
34-5 establishing insurance premiums.
34-6 Sec. 166.096 [674.016]. LIMITATION ON LIABILITY FOR
34-7 WITHHOLDING CARDIOPULMONARY RESUSCITATION AND CERTAIN OTHER
34-8 LIFE-SUSTAINING PROCEDURES. (a) A health care professional or
34-9 health care facility or entity that in good faith causes
34-10 cardiopulmonary resuscitation or certain other life-sustaining
34-11 procedures designated by the board to be withheld from a person in
34-12 accordance with this subchapter [chapter] is not civilly liable for
34-13 that action.
34-14 (b) A health care professional or health care facility or
34-15 entity that in good faith participates in withholding
34-16 cardiopulmonary resuscitation or certain other life-sustaining
34-17 procedures designated by the board from a person in accordance with
34-18 this subchapter [chapter] is not civilly liable for that action.
34-19 (c) A health care professional or health care facility or
34-20 entity that in good faith participates in withholding
34-21 cardiopulmonary resuscitation or certain other life-sustaining
34-22 procedures designated by the board from a person in accordance with
34-23 this subchapter [chapter] is not criminally liable or guilty of
34-24 unprofessional conduct as a result of that action.
34-25 (d) A health care professional or health care facility or
34-26 entity that in good faith causes or participates in withholding
34-27 cardiopulmonary resuscitation or certain other life-sustaining
35-1 procedures designated by the board from a person in accordance with
35-2 this subchapter [chapter] and rules adopted under this subchapter
35-3 [chapter] is not in violation of any other licensing or regulatory
35-4 laws or rules of this state and is not subject to any disciplinary
35-5 action or sanction by any licensing or regulatory agency of this
35-6 state as a result of that action.
35-7 Sec. 166.097 [674.017]. LIMITATION ON LIABILITY FOR FAILURE
35-8 TO EFFECTUATE OUT-OF-HOSPITAL DNR ORDER. (a) A health care
35-9 professional or health care facility or entity that has no actual
35-10 knowledge of an out-of-hospital DNR order is not civilly or
35-11 criminally liable for failing to act in accordance with the order.
35-12 (b) A health care professional or health care facility or
35-13 entity is not civilly or criminally liable for failing to
35-14 effectuate an out-of-hospital DNR order.
35-15 (c) If an attending physician refuses to execute or comply
35-16 with an out-of-hospital DNR order, the physician shall inform the
35-17 person, the legal guardian or qualified relatives of the person, or
35-18 the agent of the person having a durable power of attorney for
35-19 health care and, if the person or another authorized to act on
35-20 behalf of the person so directs, shall make a reasonable effort to
35-21 transfer the person to another physician who is willing to execute
35-22 or comply with an out-of-hospital DNR order.
35-23 Sec. 166.098 [674.018]. HONORING OUT-OF-HOSPITAL DNR ORDER
35-24 DOES NOT CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not
35-25 commit an offense under Section 22.08, Penal Code, by withholding
35-26 cardiopulmonary resuscitation or certain other life-sustaining
35-27 procedures designated by the board from a person in accordance with
36-1 this subchapter [chapter].
36-2 Sec. 166.099 [674.019]. CRIMINAL PENALTY; PROSECUTION. (a)
36-3 A person commits an offense if the person intentionally conceals,
36-4 cancels, defaces, obliterates, or damages another person's
36-5 out-of-hospital DNR order or DNR identification device without that
36-6 person's consent or the consent of the person or persons authorized
36-7 to execute or issue an out-of-hospital DNR order on behalf of the
36-8 person under this subchapter [chapter]. An offense under this
36-9 subsection is a Class A misdemeanor.
36-10 (b) A person is subject to prosecution for criminal homicide
36-11 under Chapter 19, Penal Code, if the person, with the intent to
36-12 cause cardiopulmonary resuscitation or certain other
36-13 life-sustaining procedures designated by the board to be withheld
36-14 from another person contrary to the other person's desires,
36-15 falsifies or forges an out-of-hospital DNR order or intentionally
36-16 conceals or withholds personal knowledge of a revocation and
36-17 thereby directly causes cardiopulmonary resuscitation and certain
36-18 other life-sustaining procedures designated by the board to be
36-19 withheld from the other person with the result that the other
36-20 person's death is hastened.
36-21 Sec. 166.100 [674.020]. PREGNANT PERSONS. A person may not
36-22 withhold cardiopulmonary resuscitation or certain other
36-23 life-sustaining procedures designated by the board under this
36-24 subchapter [chapter] from a person known by the responding health
36-25 care professionals to be pregnant.
36-26 Sec. 166.101 [674.021]. MERCY KILLING NOT CONDONED. This
36-27 subchapter [chapter] does not condone, authorize, or approve mercy
37-1 killing or permit an affirmative or deliberate act or omission to
37-2 end life except to permit the natural process of dying as provided
37-3 by this subchapter [chapter].
37-4 Sec. 166.102 [674.022]. LEGAL RIGHT OR RESPONSIBILITY NOT
37-5 AFFECTED. This subchapter [chapter] does not impair or supersede
37-6 any legal right or responsibility a person may have under a
37-7 constitution, other statute, regulation, or court decision to
37-8 effect the withholding of cardiopulmonary resuscitation or certain
37-9 other life-sustaining procedures designated by the board.
37-10 Sec. 166.103 [674.023]. DUTIES OF DEPARTMENT AND BOARD. (a)
37-11 The board shall, on the recommendation of the department, adopt
37-12 all reasonable and necessary rules to carry out the purposes of
37-13 this subchapter [chapter], including rules:
37-14 (1) adopting a statewide out-of-hospital DNR order
37-15 protocol that sets out standard procedures for the withholding of
37-16 cardiopulmonary resuscitation and certain other life-sustaining
37-17 procedures by health care professionals acting in out-of-hospital
37-18 settings;
37-19 (2) designating life-sustaining procedures that may be
37-20 included in an out-of-hospital DNR order, including all procedures
37-21 listed in Section 166.081(7)(A)(i) through (vi) [674.001(14)(A)(i)
37-22 through (vi)]; and
37-23 (3) governing recordkeeping in circumstances in which
37-24 an out-of-hospital DNR order or DNR identification device is
37-25 encountered by responding health care professionals.
37-26 (b) The rules adopted by the board under Subsection (a) are
37-27 not effective until approved by the Texas State Board of Medical
38-1 Examiners.
38-2 (c) Local emergency medical services authorities may adopt
38-3 local out-of-hospital DNR order protocols if the local protocols do
38-4 not conflict with the statewide out-of-hospital DNR order protocol
38-5 adopted by the board.
38-6 (d) The board by rule shall specify a distinctive standard
38-7 design for a necklace and a bracelet DNR identification device that
38-8 signifies, when worn by a person, that the possessor has executed
38-9 or issued a valid out-of-hospital DNR order under this subchapter
38-10 [chapter] or is a person for whom a valid out-of-hospital DNR order
38-11 has been executed or issued.
38-12 (e) The department shall report to the board from time to
38-13 time regarding issues identified in emergency medical services
38-14 responses in which an out-of-hospital DNR order or DNR
38-15 identification device is encountered. The report may contain
38-16 recommendations to the board for necessary modifications to the
38-17 form of the standard out-of-hospital DNR order or the designated
38-18 life-sustaining procedures listed in the standard out-of-hospital
38-19 DNR order, the statewide out-of-hospital DNR order protocol, or the
38-20 DNR identification devices.
38-21 Sec. 166.104 [674.024]. RECOGNITION OF OUT-OF-HOSPITAL DNR
38-22 ORDER EXECUTED OR ISSUED IN OTHER STATE. An out-of-hospital DNR
38-23 order executed, issued, or authorized in another state or a
38-24 territory or possession of the United States in compliance with the
38-25 law of that jurisdiction is effective for purposes of this
38-26 subchapter [chapter].
38-27 SECTION 1.05. Chapter 135, Civil Practice and Remedies Code,
39-1 is transferred to Subtitle H, Title 2, Health and Safety Code, is
39-2 redesignated as Subchapter D, Chapter 166, Health and Safety Code,
39-3 and is amended to read as follows:
39-4 SUBCHAPTER D [CHAPTER 135]. DURABLE POWER OF ATTORNEY FOR
39-5 HEALTH CARE
39-6 Sec. 166.151 [135.001]. DEFINITIONS. In this subchapter
39-7 [chapter]:
39-8 (1) "Adult" means a person 18 years of age or older or
39-9 a person under 18 years of age who has had the disabilities of
39-10 minority removed.
39-11 (2) "Agent" means an adult to whom authority to make
39-12 health care decisions is delegated under a durable power of
39-13 attorney for health care.
39-14 (3) ["Attending physician" means the physician,
39-15 selected by or assigned to a patient, who has primary
39-16 responsibility for the treatment and care of the patient.]
39-17 [(4) "Capacity to make health care decisions" means
39-18 the ability to understand and appreciate the nature and
39-19 consequences of a health care decision, including the significant
39-20 benefits and harms of and reasonable alternatives to any proposed
39-21 health care.]
39-22 [(5) "Durable power of attorney for health care" means
39-23 a document delegating to an agent the authority to make health care
39-24 decisions as provided by this chapter.]
39-25 [(6) "Health care decision" means consent, refusal to
39-26 consent, or withdrawal of consent to health care, treatment,
39-27 service, or procedure to maintain, diagnose, or treat an
40-1 individual's physical or mental condition.]
40-2 [(7)] "Health care provider" means an individual or
40-3 facility licensed, certified, or otherwise authorized to administer
40-4 health care, for profit or otherwise, in the ordinary course of
40-5 business or professional practice and includes a physician.
40-6 (4) [(8) "Physician" means:]
40-7 [(A) a physician licensed by the Texas State
40-8 Board of Medical Examiners; or]
40-9 [(B) a physician with proper credentials who
40-10 holds a commission in a branch of the armed services of the United
40-11 States and who is serving on active duty in this state.]
40-12 [(9)] "Principal" means an adult who has executed a
40-13 durable power of attorney for health care.
40-14 (5) [(10)] "Residential care provider" means an
40-15 individual or facility licensed, certified, or otherwise authorized
40-16 to operate, for profit or otherwise, a residential care home.
40-17 Sec. 166.152 [135.002]. SCOPE AND DURATION OF AUTHORITY.
40-18 (a) Subject to this subchapter [chapter] or any express
40-19 limitation on the authority of the agent contained in the durable
40-20 power of attorney for health care, the agent may make any health
40-21 care decision on the principal's behalf that the principal could
40-22 make if the principal were competent [but for the principal's lack
40-23 of capacity to make health care decisions].
40-24 (b) An agent may exercise authority only if the principal's
40-25 attending physician certifies in writing and files the
40-26 certification in the principal's medical record that, based on the
40-27 attending physician's reasonable medical judgment, the principal is
41-1 incompetent [lacks capacity to make health care decisions].
41-2 (c) Notwithstanding any other provisions of this subchapter
41-3 [chapter], treatment may not be given to or withheld from the
41-4 principal if the principal objects regardless of whether, at the
41-5 time of the objection:
41-6 (1) a durable power of attorney for health care is in
41-7 effect; or
41-8 (2) the principal is competent [has the capacity to
41-9 make health care decisions].
41-10 (d) The principal's attending physician shall make
41-11 reasonable efforts to inform the principal of any proposed
41-12 treatment or of any proposal to withdraw or withhold treatment
41-13 before implementing an agent's directive.
41-14 (e) After consultation with the attending physician and
41-15 other health care providers, the agent shall make a health care
41-16 decision:
41-17 (1) according to the agent's knowledge of the
41-18 principal's wishes, including the principal's religious and moral
41-19 beliefs; or
41-20 (2) if the agent does not know the principal's wishes,
41-21 according to the agent's assessment of the principal's best
41-22 interests.
41-23 (f) Notwithstanding any other provision of this subchapter
41-24 [chapter], an agent may not consent to:
41-25 (1) voluntary inpatient mental health services;
41-26 (2) convulsive treatment;
41-27 (3) psychosurgery;
42-1 (4) abortion; or
42-2 (5) neglect of the principal through the omission of
42-3 care primarily intended to provide for the comfort of the
42-4 principal.
42-5 (g) The power of attorney is effective indefinitely on
42-6 execution as provided by this subchapter [chapter] and delivery of
42-7 the document to the agent, unless it is revoked as provided by this
42-8 subchapter [chapter] or the principal becomes competent [regains
42-9 the capacity to make health care decisions]. If the durable power
42-10 of attorney includes an expiration date and on that date the
42-11 principal becomes incompetent [lacks the capacity to make health
42-12 care decisions], the power of attorney continues to be effective
42-13 until the principal becomes competent [regains the capacity to make
42-14 health care decisions] unless it is revoked as provided by this
42-15 subchapter [chapter].
42-16 Sec. 166.153 [135.003]. PERSONS WHO MAY NOT EXERCISE
42-17 AUTHORITY OF AGENT. A person may not exercise the authority of an
42-18 agent while the person serves as:
42-19 (1) the principal's health care provider;
42-20 (2) an employee of the principal's health care
42-21 provider unless the person is a relative of the principal;
42-22 (3) the principal's residential care provider; or
42-23 (4) an employee of the principal's residential care
42-24 provider unless the person is a relative of the principal.
42-25 Sec. 166.154 [135.004]. EXECUTION AND WITNESSES. (a) The
42-26 durable power of attorney for health care must be signed by the
42-27 principal in the presence of at least two [or more] subscribing
43-1 witnesses.
43-2 (b) A witness must possess the qualifications and be subject
43-3 to the restrictions provided by Section 166.003. In addition, a
43-4 witness may not, at the time of execution, be[:]
43-5 [(1)] the agent[;]
43-6 [(2) the principal's health or residential care
43-7 provider or the provider's employee;]
43-8 [(3) the principal's spouse or heir;]
43-9 [(4) a person entitled to any part of the estate of
43-10 the principal on the death of the principal under a will or deed in
43-11 existence or by operation of law; or]
43-12 [(5) any other person who has any claim against the
43-13 estate] of the principal.
43-14 (c) The witnesses shall affirm that, at the time the durable
43-15 power of attorney for health care was signed, the principal:
43-16 (1) appeared to be competent [of sound mind to make a
43-17 health care decision];
43-18 (2) stated in the witness's presence that the
43-19 principal was aware of the nature of the durable power of attorney
43-20 for health care and that the principal was signing the document
43-21 voluntarily and free from any duress; and
43-22 (3) requested that the witness serve as a witness to
43-23 the principal's execution of the document.
43-24 (d) If the principal is physically unable to sign, another
43-25 person may sign the durable power of attorney for health care with
43-26 the principal's name in the principal's presence and at the
43-27 principal's express direction.
44-1 Sec. 166.155 [135.005]. REVOCATION. (a) A durable power of
44-2 attorney for health care is revoked by:
44-3 (1) oral or written notification at any time by the
44-4 principal to the agent or a licensed or certified health or
44-5 residential care provider or by any other act evidencing a specific
44-6 intent to revoke the power, without regard to whether the principal
44-7 is competent or the principal's mental state[, competency, or
44-8 capacity to make health care decisions];
44-9 (2) execution by the principal of a subsequent durable
44-10 power of attorney for health care; or
44-11 (3) the divorce of the principal and spouse, if the
44-12 spouse is the principal's agent.
44-13 (b) A principal's licensed or certified health or
44-14 residential care provider who is informed of or provided with a
44-15 revocation of a durable power of attorney for health care shall
44-16 immediately record the revocation in the principal's medical record
44-17 and give notice of the revocation to the agent and any known health
44-18 and residential care providers currently responsible for the
44-19 principal's care.
44-20 Sec. 166.156 [135.006]. APPOINTMENT OF GUARDIAN. (a) On
44-21 motion filed in connection with a petition for appointment of a
44-22 guardian or, if a guardian has been appointed, on petition of the
44-23 guardian, a probate court shall determine whether to suspend or
44-24 revoke the authority of the agent.
44-25 (b) The court shall consider the preferences of the
44-26 principal as expressed in the durable power of attorney for health
44-27 care.
45-1 (c) During the pendency of the court's determination under
45-2 Subsection (a), the guardian has the sole authority to make any
45-3 health care decisions unless the court orders otherwise. If a
45-4 guardian has not been appointed, the agent has the authority to
45-5 make any health care decisions unless the court orders otherwise.
45-6 (d) A person, including any attending physician or health or
45-7 residential care provider, who does not have actual knowledge of
45-8 the appointment of a guardian or an order of the court granting
45-9 authority to someone other than the agent to make health care
45-10 decisions is not subject to criminal or civil liability and has not
45-11 engaged in unprofessional conduct for implementing an agent's
45-12 health care decision.
45-13 Sec. 166.157 [135.007]. DISCLOSURE OF MEDICAL INFORMATION.
45-14 Subject to any limitations in the durable power of attorney for
45-15 health care, an agent may, for the purpose of making a health care
45-16 decision:
45-17 (1) request, review, and receive any information, oral
45-18 or written, regarding the principal's physical or mental health,
45-19 including medical and hospital records;
45-20 (2) execute a release or other document required to
45-21 obtain the information; and
45-22 (3) consent to the disclosure of the information.
45-23 Sec. 166.158 [135.008]. DUTY OF HEALTH OR RESIDENTIAL CARE
45-24 PROVIDER. (a) A principal's health or residential care provider
45-25 and an employee of the provider who knows of the existence of the
45-26 principal's durable power of attorney for health care shall follow
45-27 a directive of the principal's agent to the extent it is consistent
46-1 with the desires of the principal, this subchapter [chapter], and
46-2 the durable power of attorney for health care.
46-3 (b) The attending physician does not have a duty to verify
46-4 that the agent's directive is consistent with the principal's
46-5 wishes or religious or moral beliefs.
46-6 (c) A principal's health or residential care provider who
46-7 finds it impossible to follow a directive by the agent because of a
46-8 conflict with this subchapter [chapter] or the durable power of
46-9 attorney for health care shall inform the agent as soon as is
46-10 reasonably possible. The agent may select another attending
46-11 physician.
46-12 (d) This subchapter [chapter] may not be construed to
46-13 require a health or residential care provider who is not a
46-14 physician to act in a manner contrary to a physician's order.
46-15 Sec. 166.159 [135.009]. DISCRIMINATION RELATING TO EXECUTION
46-16 OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE. A health or
46-17 residential care provider, health care service plan, insurer
46-18 issuing disability insurance, self-insured employee benefit plan,
46-19 or nonprofit hospital service plan may not:
46-20 (1) charge a person a different rate solely because
46-21 the person has executed a durable power of attorney for health
46-22 care;
46-23 (2) require a person to execute a durable power of
46-24 attorney for health care before:
46-25 (A) admitting the person to a hospital, nursing
46-26 home, or residential care home;
46-27 (B) insuring the person; or
47-1 (C) allowing the person to receive health or
47-2 residential care; or
47-3 (3) refuse health or residential care to a person
47-4 solely because the person has executed a durable power of attorney
47-5 for health care.
47-6 Sec. 166.160 [135.010]. LIMITATION ON LIABILITY. (a) An
47-7 agent is not subject to criminal or civil liability for a health
47-8 care decision if the decision is made in good faith under the terms
47-9 of the durable power of attorney for health care and the provisions
47-10 of this subchapter [chapter].
47-11 (b) An attending physician, health or residential care
47-12 provider, or a person acting as an agent for or under the
47-13 physician's or provider's control is not subject to criminal or
47-14 civil liability and has not engaged in unprofessional conduct for
47-15 an act or omission if the act or omission:
47-16 (1) is done in good faith under the terms of the
47-17 durable power of attorney for health care, the directives of the
47-18 agent, and the provisions of this subchapter [chapter]; and
47-19 (2) does not constitute a failure to exercise due care
47-20 in the provision of health care services.
47-21 (c) An attending physician, health or residential care
47-22 provider, or person acting as an agent for or under the physician's
47-23 or provider's control has not engaged in unprofessional conduct
47-24 for:
47-25 (1) failure to act as required by the directive of an
47-26 agent or a durable power of attorney for health care if the
47-27 physician, provider, or person was not provided with a copy of the
48-1 durable power of attorney for health care or had no knowledge of a
48-2 directive; or
48-3 (2) acting as required by an agent's directive if the
48-4 durable power of attorney for health care has expired or been
48-5 revoked but the physician, provider, or person does not have
48-6 knowledge of the expiration or revocation.
48-7 Sec. 166.161 [135.011]. LIABILITY FOR HEALTH CARE COSTS.
48-8 Liability for the cost of health care provided as a result of the
48-9 agent's decision is the same as if the health care were provided as
48-10 a result of the principal's decision.
48-11 Sec. 166.162 [135.012]. NATURAL DEATH ACT. To the extent
48-12 that a durable power of attorney for health care conflicts with a
48-13 directive or treatment decision executed under Subchapter B [the
48-14 Natural Death Act (Chapter 672, Health and Safety Code)], the
48-15 instrument executed later in time controls. A physician who
48-16 withholds or withdraws life-sustaining procedures from a principal
48-17 with a terminal condition as required by an agent's directive is
48-18 not required to comply with Subchapter B [the Natural Death Act].
48-19 Sec. 166.163 [135.013]. ENFORCEABILITY OF DURABLE POWER OF
48-20 ATTORNEY EXECUTED IN ANOTHER JURISDICTION. This subchapter
48-21 [chapter] does not limit the enforceability of a durable power of
48-22 attorney for health care or similar instrument executed in another
48-23 state or jurisdiction if the instrument complies with the law of
48-24 the state or jurisdiction.
48-25 Sec. 166.164 [135.014]. DISCLOSURE STATEMENT. A durable
48-26 power of attorney for health care is not effective unless the
48-27 principal, before executing the durable power of attorney for
49-1 health care, signs a statement that the principal has received a
49-2 disclosure statement and has read and understood its contents.
49-3 Sec. 166.165 [135.015]. FORM OF DISCLOSURE STATEMENT. The
49-4 disclosure statement must be in substantially the following form:
49-5 INFORMATION CONCERNING THE DURABLE POWER OF ATTORNEY FOR
49-6 HEALTH CARE
49-7 THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS
49-8 DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS:
49-9 Except to the extent you state otherwise, this document
49-10 gives the person you name as your agent the authority to make
49-11 any and all health care decisions for you in accordance with
49-12 your wishes, including your religious and moral beliefs, when
49-13 you are no longer capable of making them yourself. Because
49-14 "health care" means any treatment, service, or procedure to
49-15 maintain, diagnose, or treat your physical or mental
49-16 condition, your agent has the power to make a broad range of
49-17 health care decisions for you. Your agent may consent,
49-18 refuse to consent, or withdraw consent to medical treatment
49-19 and may make decisions about withdrawing or withholding
49-20 life-sustaining treatment. Your agent may not consent to
49-21 voluntary inpatient mental health services, convulsive
49-22 treatment, psychosurgery, or abortion. A physician must
49-23 comply with your agent's instructions or allow you to be
49-24 transferred to another physician.
49-25 Your agent's authority begins when your doctor
49-26 certifies that you lack the capacity to make health care
49-27 decisions.
50-1 Your agent is obligated to follow your instructions
50-2 when making decisions on your behalf. Unless you state
50-3 otherwise, your agent has the same authority to make
50-4 decisions about your health care as you would have had.
50-5 It is important that you discuss this document with
50-6 your physician or other health care provider before you sign
50-7 it to make sure that you understand the nature and range of
50-8 decisions that may be made on your behalf. If you do not
50-9 have a physician, you should talk with someone else who is
50-10 knowledgeable about these issues and can answer your
50-11 questions. You do not need a lawyer's assistance to complete
50-12 this document, but if there is anything in this document that
50-13 you do not understand, you should ask a lawyer to explain it
50-14 to you.
50-15 The person you appoint as agent should be someone you
50-16 know and trust. The person must be 18 years of age or older
50-17 or a person under 18 years of age who has had the
50-18 disabilities of minority removed. If you appoint your health
50-19 or residential care provider (e.g., your physician or an
50-20 employee of a home health agency, hospital, nursing home, or
50-21 residential care home, other than a relative), that person
50-22 has to choose between acting as your agent or as your health
50-23 or residential care provider; the law does not permit a
50-24 person to do both at the same time.
50-25 You should inform the person you appoint that you want
50-26 the person to be your health care agent. You should discuss
50-27 this document with your agent and your physician and give
51-1 each a signed copy. You should indicate on the document
51-2 itself the people and institutions who have signed copies.
51-3 Your agent is not liable for health care decisions made in
51-4 good faith on your behalf.
51-5 Even after you have signed this document, you have the
51-6 right to make health care decisions for yourself as long as
51-7 you are able to do so and treatment cannot be given to you or
51-8 stopped over your objection. You have the right to revoke
51-9 the authority granted to your agent by informing your agent
51-10 or your health or residential care provider orally or in
51-11 writing or by your execution of a subsequent durable power of
51-12 attorney for health care. Unless you state otherwise, your
51-13 appointment of a spouse dissolves on divorce.
51-14 This document may not be changed or modified. If you
51-15 want to make changes in the document, you must make an
51-16 entirely new one.
51-17 You may wish to designate an alternate agent in the
51-18 event that your agent is unwilling, unable, or ineligible to
51-19 act as your agent. Any alternate agent you designate has the
51-20 same authority to make health care decisions for you.
51-21 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS SIGNED IN
51-22 THE PRESENCE OF TWO [OR MORE] QUALIFIED WITNESSES. THE
51-23 FOLLOWING PERSONS MAY NOT ACT AS WITNESSES:
51-24 (1) the person you have designated as your
51-25 agent;
51-26 (2) a person related to you by blood or marriage
51-27 [your health or residential care provider or an employee of
52-1 your health or residential care provider];
52-2 (3) a person entitled to any part of your estate
52-3 after your death under a will or codicil executed by you or
52-4 by operation of law [your spouse];
52-5 (4) your attending physician; [your lawful heirs
52-6 or beneficiaries named in your will or a deed; or]
52-7 (5) an employee of the attending physician;
52-8 (6) an employee of a health care facility in
52-9 which you are a patient if the employee is providing direct
52-10 patient care to you or is an officer, director, partner, or
52-11 business office employee of the health care facility or of
52-12 any parent organization of the health care facility;
52-13 (7) a patient in a health care facility in which
52-14 you are a patient; or
52-15 (8) a person who, at the time this power of
52-16 attorney is executed, has a claim against any part of your
52-17 estate after your death [creditors or persons who have a
52-18 claim against you].
52-19 Sec. 166.166 [135.016]. FORM OF DURABLE POWER OF ATTORNEY.
52-20 The durable power of attorney for health care must be in
52-21 substantially the following form:
52-22 DURABLE POWER OF ATTORNEY FOR HEALTH CARE
52-23 DESIGNATION OF HEALTH CARE AGENT.
52-24 I,_____________________(insert your name) appoint:
52-25 Name:____________________
52-26 Address:_________________
52-27 Phone____________________
53-1 as my agent to make any and all health care decisions for me,
53-2 except to the extent I state otherwise in this document. This
53-3 durable power of attorney for health care takes effect if I become
53-4 unable to make my own health care decisions and this fact is
53-5 certified in writing by my physician.
53-6 LIMITATIONS ON THE DECISION-MAKING AUTHORITY OF MY AGENT ARE AS
53-7 FOLLOWS:___________________________
53-8 _______________________________________________________ DESIGNATION
53-9 OF ALTERNATE AGENT.
53-10 (You are not required to designate an alternate agent but you
53-11 may do so. An alternate agent may make the same health care
53-12 decisions as the designated agent if the designated agent is unable
53-13 or unwilling to act as your agent. If the agent designated is your
53-14 spouse, the designation is automatically revoked by law if your
53-15 marriage is dissolved.)
53-16 If the person designated as my agent is unable or unwilling
53-17 to make health care decisions for me, I designate the following
53-18 persons to serve as my agent to make health care decisions for me
53-19 as authorized by this document, who serve in the following order:
53-20 A. First Alternate Agent
53-21 Name:________________________
53-22 Address:_____________________
53-23 Phone________________________
53-24 B. Second Alternate Agent
53-25 Name:________________________
53-26 Address:_____________________
53-27 Phone________________________
54-1 The original of this document is kept
54-2 at________________________________________________
54-3 __________________________________________________
54-4 __________________________________________________
54-5 The following individuals or institutions have signed copies:
54-6 Name:____________________________________________
54-7 Address:_________________________________________
54-8 _________________________________________________
54-9 Name:____________________________________________
54-10 Address:_________________________________________
54-11 _________________________________________________
54-12 DURATION.
54-13 I understand that this power of attorney exists indefinitely
54-14 from the date I execute this document unless I establish a shorter
54-15 time or revoke the power of attorney. If I am unable to make
54-16 health care decisions for myself when this power of attorney
54-17 expires, the authority I have granted my agent continues to exist
54-18 until the time I become able to make health care decisions for
54-19 myself.
54-20 (IF APPLICABLE) This power of attorney ends on the following
54-21 date:________________
54-22 PRIOR DESIGNATIONS REVOKED.
54-23 I revoke any prior durable power of attorney for health care.
54-24 ACKNOWLEDGMENT OF DISCLOSURE STATEMENT.
54-25 I have been provided with a disclosure statement explaining
54-26 the effect of this document. I have read and understand that
54-27 information contained in the disclosure statement.
55-1 (YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY.) I sign my
55-2 name to this durable power of attorney for health care on _____ day
55-3 of ________ 19 __ at____________(City and State)
55-4 ___________(Signature)
55-5 ________________(Print Name)
55-6 STATEMENT OF WITNESSES.
55-7 I declare under penalty of perjury that the principal has
55-8 identified himself or herself to me, that the principal signed or
55-9 acknowledged this durable power of attorney in my presence, that I
55-10 believe the principal to be of sound mind, that the principal has
55-11 affirmed that the principal is aware of the nature of the document
55-12 and is signing it voluntarily and free from duress, that the
55-13 principal requested that I serve as witness to the principal's
55-14 execution of this document, that I am not the person appointed as
55-15 agent by this document, and that I am not related to the principal
55-16 by blood or marriage, I would not be entitled to any portion of the
55-17 principal's estate on the principal's death, I am not the attending
55-18 physician of the principal or an employee of the attending
55-19 physician, I am not a patient in the health care facility in which
55-20 the principal is a patient, and I have no claim against any portion
55-21 of the principal's estate on the principal's death. Furthermore, if
55-22 I am an employee of a health care facility in which the principal
55-23 is a patient, I am not involved in providing direct patient care to
55-24 the principal and am not an officer, director, partner, or
55-25 business office employee of the health care facility or of any
55-26 parent organization of the health care facility [a provider of
55-27 health or residential care, an employee of a provider of health or
56-1 residential care, the operator of a community care facility, or an
56-2 employee of an operator of a health care facility.]
56-3 [I declare that I am not related to the principal by blood,
56-4 marriage, or adoption and that to the best of my knowledge I am not
56-5 entitled to any part of the estate of the principal on the death of
56-6 the principal under a will or by operation of law].
56-7 Witness Signature:_______________
56-8 Print Name:_____________________Date:____________
56-9 Address:_______________________________________________
56-10 Witness Signature:_______________
56-11 Print Name:_____________________Date:____________
56-12 Address:_______________________________________________
56-13 Sec. 166.167 [135.017]. CIVIL ACTION. (a) A person who is
56-14 a near relative of the principal or a responsible adult who is
56-15 directly interested in the principal, including a guardian, social
56-16 worker, physician, or clergyman, may bring an action in district
56-17 court to request that the durable power of attorney for health care
56-18 be revoked because the principal, at the time the durable power of
56-19 attorney for health care was signed:
56-20 (1) was not competent [of sound mind to make a health
56-21 care decision]; or
56-22 (2) was under duress, fraud, or undue influence.
56-23 (b) The action may be brought in the county of the
56-24 principal's residence or the residence of the person bringing the
56-25 action.
56-26 (c) During the pendency of the action, the authority of the
56-27 agent to make health care decisions continues in effect unless the
57-1 district court orders otherwise.
57-2 Sec. 166.168 [135.018]. OTHER RIGHTS OR RESPONSIBILITIES NOT
57-3 AFFECTED. This subchapter [chapter] does not limit or impair any
57-4 legal right or responsibility that any person, including a
57-5 physician or health or residential care provider, may have to make
57-6 or implement health care decisions on behalf of a person.
57-7 ARTICLE 2. CONFORMING AMENDMENTS
57-8 SECTION 2.01. Section 313.003(a), Health and Safety Code,
57-9 is amended to read as follows:
57-10 (a) This chapter does not apply to:
57-11 (1) a decision to withhold or withdraw life-sustaining
57-12 treatment from qualified terminal patients under Subchapter B,
57-13 Chapter 166 [the terms of Chapter 672];
57-14 (2) a health care decision made under a durable power
57-15 of attorney for health care under Subchapter D, Chapter 166
57-16 [Chapter 135, Civil Practice and Remedies Code], or under Chapter
57-17 XII, Texas Probate Code;
57-18 (3) consent to medical treatment of minors under
57-19 Chapter 32 [35], Family Code;
57-20 (4) consent for emergency care under Chapter 773;
57-21 (5) hospital patient transfers under Chapter 241; or
57-22 (6) a patient's legal guardian who has the authority
57-23 to make a decision regarding the patient's medical treatment.
57-24 ARTICLE 3. TRANSITION AND EMERGENCY CLAUSE
57-25 SECTION 3.01. This Act takes effect January 1, 1998.
57-26 SECTION 3.02. The change in law made by this Act does not
57-27 affect the validity of a document executed under Chapter 672 or
58-1 674, Health and Safety Code, or Chapter 135, Civil Practice and
58-2 Remedies Code, before the effective date of this Act. A document
58-3 executed before the effective date of this Act is governed by the
58-4 law in effect on the date the document was executed and that law
58-5 continues in effect for that purpose.
58-6 SECTION 3.03. (a) The change in law made by this Act
58-7 applies only to the punishment for an offense committed on or after
58-8 the effective date of this Act. For purposes of this section, an
58-9 offense is committed before the effective date of this Act if any
58-10 element of the offense occurs before the effective date.
58-11 (b) An offense committed before the effective date of this
58-12 Act is covered by the law in effect when the offense was committed,
58-13 and the former law is continued in effect for that purpose.
58-14 SECTION 3.04. The importance of this legislation and the
58-15 crowded condition of the calendars in both houses create an
58-16 emergency and an imperative public necessity that the
58-17 constitutional rule requiring bills to be read on three several
58-18 days in each house be suspended, and this rule is hereby suspended.